Cirrhotic cardiomyopathy is associated with poor outcomes in patients with cirrhosis. We investigated if subclinical cardiac morphologic and functional modifications can influence survival in patients with cirrhosis during follow‐up. A series of patients with cirrhosis without cardiovascular or pulmonary disease underwent standard and tissue Doppler echocardiography to assess left ventricular geometry, systolic/diastolic function, and the main haemodynamic parameters. After baseline evaluation 115 patients with cirrhosis were followed up for at least 6 years. During follow‐up 54 patients died (47%). On univariate analysis, age, body surface area (BSA), Model for End‐Stage Liver Disease (MELD), mean arterial pressure, heart rate, cardiac index, systemic vascular resistance index, and the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/è) were associated with increased risk of death. In a Cox hazard regression analysis including these factors and other hypothesized important factors (but not MELD), increased age (P = 0.04) and left atrial dimension (P = 0.005) and lower BSA (P = 0.03) were the strongest predictors of death. When MELD was included in the analysis, the main predictors were MELD, age, and BSA. When multivariate analysis was performed incorporating only cardiovascular parameters, increased E/è (P = 0.003) and heart rate (P = 0.03) and reduced mean blood pressure (P = 0.01) were significantly associated with poor prognosis. Conclusion: In a large cohort of patients with cirrhosis and after a long follow‐up, MELD, age, and BSA were the main predictors of death; among cardiovascular parameters, left atrium enlargement, increased heart rate and E/è, and reduced mean blood pressure were independent predictors of death. (Hepatology 2018).

中文翻译：

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肝硬化患者死亡的心血管预测因素

肝硬化心肌病与肝硬化患者的不良预后有关。我们调查了亚临床心脏形态学和功能改变是否会影响随访期间肝硬化患者的生存率。一系列无心血管或肺部疾病的肝硬化患者接受了标准和组织多普勒超声心动图检查，以评估左心室几何形状、收缩/舒张功能和主要血液动力学参数。基线评估后，115 名肝硬化患者至少随访 6 年。在随访期间，54 名患者死亡（47%）。在单变量分析中，年龄、体表面积 (BSA)、终末期肝病模型 (MELD)、平均动脉压、心率、心脏指数、全身血管阻力指数、和二尖瓣多普勒早期充盈速度与组织多普勒早期舒张二尖瓣环速度 (E/è) 的比值与死亡风险增加有关。在包括这些因素和其他假设的重要因素（但不包括 MELD）的 Cox 风险回归分析中，年龄增加（P = 0.04）和左心房尺寸（P = 0.005）和 BSA 降低（P = 0.03）是死亡的最强预测因子. 当 MELD 被纳入分析时，主要预测因素是 MELD、年龄和 BSA。当仅纳入心血管参数进行多变量分析时，增加的 E/è (P = 0.003) 和心率 (P = 0.03) 以及降低的平均血压 (P = 0.01) 与不良预后显着相关。结论：在大量肝硬化患者中，经过长期随访，MELD、年龄、和 BSA 是死亡的主要预测因子；在心血管参数中，左心房扩大、心率和 E/è 增加以及平均血压降低是死亡的独立预测因子。（肝病学 2018）。